Psychological interventions for adults with asthma.

BACKGROUND: Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease. OBJECTIVES: To assess the effectiveness of psychological interventions for adults with asthma. SEARCH STRATEGY: The Cochrane Airways Group Specialised Register and PsycINFO were searched with pre-defined terms up until August 2005. SELECTION CRITERIA: Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a form of control in adult participants were included in the review. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted. MAIN RESULTS: Fourteen studies, involving 617 particpants, were included in the review, however study quality was poor and sample sizes were frequently small. However, some pooled effects were analysed. The use of 'as needed' medications was reduced in two studies, (47 patients), by relaxation therapy (OR 4.47, CI 1.22 to 16.44). There was no significant difference in FEV1 for relaxation therapy in four studies of 150 patients, (SMD -0.01, CI -0.41 to 0.40). Quality of life, measured using the Asthma Quality of Life Questionnaire in two studies, (48 patients), showed a positive effect following CBT (WMD 0.71, CI 0.23 to 1.19). Peak Expiratory Flow outcome data in two studies, (51 patients), indicated a significant difference in favour of bio-feedback therapy (SMD 0.66, CI 0.09 to 1.23). The remainder of the findings between studies were conflicting. This may have been due to the different types of interventions used and the deficiencies in trial design. AUTHORS' CONCLUSIONS: This review was unable to draw firm conclusions for the role of psychological interventions in asthma due to the absence of an adequate evidence base. Larger, well-conducted and reported randomised trials are required in this area, in order to determine the effects of these techniques in the treatment of asthma in adults.

Psychotherapeutic interventions for adults with asthma.

BACKGROUND: Many people have asthma, and for some their symptoms may be triggered by psychological factors. In addition compliance with medical therapy may have a psychological dimension. Therefore, psychological interventions aim to reduce the burden of symptoms and improve management of the disease. OBJECTIVES: To assess the effectiveness of psychological interventions for adults with asthma. SEARCH STRATEGY: The Cochrane Airways Group specialised register and PsycINFO were searched with pre-defined terms until September 2003. SELECTION CRITERIA: Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a form of control in adult participants were included in the review. DATA COLLECTION AND ANALYSIS: Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted. MAIN RESULTS: Twelve studies were included in the review, however study quality was poor and sample sizes were frequently small. No meta-analysis could be performed due to the diversity of interventions and the outcomes assessed. Findings between studies were conflicting. This may have been due to the different types of interventions used and the deficiencies in trial design. REVIEWER'S CONCLUSIONS: This review was unable to draw firm conclusions for the role of psychological interventions in asthma due to the absence of an adequate evidence base. Large, well-conducted and reported randomised trials are required in this area, in order to determine the effects of these techniques in the treatment of asthma in adults.

The impact of pre-operative education on recovery following coronary artery bypass surgery. A randomized controlled clinical trial.

AIMS: Research has demonstrated the beneficial impact that pre-operative education exerts on the postoperative recovery of patients having surgery but little work has focused specifically on cardiac surgery. Therefore a randomized controlled trial was designed to elucidate the consequences of pre-operative education, given before admission, on postoperative pain, anxiety, depression and wellbeing in the 6 months following a first episode of coronary artery surgery. METHOD AND RESULTS: Three hundred and fifty-six people were randomized into the study, with 188 in the experimental and 168 in the control arms. Patients in the experimental group received the intervention, a day of education by members of the multidisciplinary team, prior to admission for surgery. Experimental and control subjects had the usual care, which involved education on admission and throughout their stay in hospital. Measurement was conducted on entry to the study, before randomization, and at 3 days, 6 weeks, 3 months and 6 months following operation. A variety of tools were used: the SF-36 Health Status questionnaire, the Hospital Anxiety and Depression scale, the General Well-Being questionnaire and a pain measurement tool. Analysis was done using the intention-totreat principle and non-parametric statistics. There were no significant differences between groups in the primary outcomes namely anxiety (P=0.09) and pain (P=0.48), or in depression (P=0.62) and wellbeing ('worn out' P=0.11; 'tense and uptight' P=0.29) 6 months after operation. This was also the case 3 days after coronary artery surgery. There was a significant difference in length of hospital stay (P=0.01) with the experimental group having the longer stay. These findings contrast with much of the existing evidence. CONCLUSION: The findings demonstrate that there is no benefit to be gained from this form of pre-operative education and that there is an associated increase in length of hospital stay. Future research could examine an ongoing programme of education and support, and might use alternative methods such as CD-ROM or the Internet.

Pre-operative education for the patient having coronary artery bypass surgery.

Patient education is an important element of care for people having a range of investigations and treatments. The potentially beneficial effect on outcomes has been explored. In particular research, and meta-analyses of the studies, have demonstrated the positive effect of pre-operative education on post-operative outcomes in patients having a variety of surgical procedures. However, application of the findings to defined groups of specialist patients may be difficult. This paper seeks to establish whether pre-operative education benefits patients following coronary artery bypass surgery and to identify the outcomes affected. A broad search strategy revealed 10 studies which examined pre-operative education and measured post-operative outcomes. Data were extracted which revealed there is limited evidence to suggest that pre-operative education benefits patient's recovery from coronary artery bypass surgery. However, this finding should be considered with caution as this body of research suffered from weak design and there was limited available data.

Quality improvement and critical care nursing.

Within the field of quality in health care there is a move away from quality assurance to a process of Continuous Quality Improvement. This change needs to be considered when designing a program to ensure quality within a critical care environment. There are several approaches available, one of which is the Dynamic Quality Improvement program. This involves solving problems and improving everyday practice whilst focusing on the recipients of the service. It utilises the Dynamic Standard Setting System (DySSSy) to define a professionally agreed level of performance for a chosen population. The standard must be achievable, observable, desirable and measurable. Patient focused nursing activities such as eye care and the prevention of pressure sores can be the basis for standard setting, audit and action to improve the care of the critically ill patient in a comprehensive program of quality initiatives.

Assessment of anxiety in hospital patients.

There has been research in North America to validate the nursing diagnosis of anxiety. As part of this work, Young used the defining characteristics and developed a tool to measure anxiety. The present research sought to extend that study in the United Kingdom, assess the anxiety-defining characteristics tool and identify key indicators of anxiety that might be useful in clinical practice. Four anxiety measurement tools, drawn from the literature, were used. These were the state trait anxiety inventory, the graphic anxiety scale, the hospital anxiety and depression scale, and the anxiety-defining characteristics tool. A random sample of 79 hospitalized patients were interviewed and their anxiety rated using all four measures. Calculation of Spearman's correlation co-efficients revealed convergent validity between the anxiety-defining characteristics tool and the state trait anxiety inventory and the anxiety score on the hospital anxiety and depression scale. Anxiety levels were found not to be affected by the age or sex of the respondent, or the length of stay or number of previous admissions. Discriminant analysis suggested that six characteristics adequately discriminated anxious subjects: sweating, faintness, tendency to blame others, continual review of things in their mind, focus on self and a lack of self-confidence. The study concluded that there is a scope for further research into these characteristics and their use in clinical practice.